Critical Access Hospitals Unlikely to Engage in Advanced EHR Use

A recent study found critical access hospitals are the least likely to engage in EHR use for quality improvement and patient engagement.

November 08, 2017 - A recent study by Julia Adler-Milstein, PhD, and Jay Holmgren at the University of Michigan found critical access hospitals (CAHs) are less likely than other hospitals to use EHR data for performance measurement and patient engagement.

According to the pair, this disparity in EHR use signals the emergence of a digital divide between CAHs and other hospitals. This digital divide could negatively affect the quality of patient care in CAHs.

“Hospital EHR adoption is widespread and many hospitals are using EHRs to support QI and patient engagement,” they wrote in a discussion of study findings. “However, this is not happening across all hospitals.”

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The findings were presented at the American Medical Informatics Association (AMIA) 2017 Annual Symposium. Researchers used national hospital data from the 2008 to 2015 American Hospital Association (AHA) Annual and IT Supplement surveys.

“We know little about whether hospitals are using EHRs in advanced ways that are critical to realizing improved patient outcomes,” stated Adler-Milstein & Holmgren. “There is concern that while hospitals with fewer resources — small, rural, safety-net — have largely kept up with EHR adoption, they are falling behind in advanced EHR use.”

In an effort to determine whether some hospitals fall behind in advanced EHR use, researchers first measured adoption rates of both basic and comprehensive EHR systems. Next, they used available questions from the 2015 Supplement to evaluate hospital EHR use and EHR data use for ten quality improvement (QI) functions and ten patient engagement functions.

The UM research team found the most common EHR-supported QI function was used to monitor patient safety, with 71 percent of hospitals supporting this function. Querying data was the least commonly used quality improvement function, with only 39 percent of hospitals utilizing the function.

The most common patient engagement functions included patient ability to view data online — which was nearly universal with 95 percent of hospitals utilizing the function — followed by the ability to download information, which had an 85 percent adoption rate. The least common function was ability to submit patient-generated data, with 36 percent of hospitals utilizing the function.

Researchers found an association between payment reforms and broad engagement in both quality improvement and patient engagement functions. Specifically, large hospitals and hospitals participating in accountable care organizations (ACO) were more likely to have eight or more EHR-enabled quality improvement functions.

Meanwhile, CAHs were least likely to be broadly engaged in either activity.

“This is concerning because EHR use for QI and patient engagement is essential to improving hospital performance,” they stated. “Our results suggest that policy efforts are impacting adoption of these functions.”

“Patient engagement functions included in the meaningful use program were among the most widely adopted functions, and participation in reform programs was associated with greater likelihood of adoption of both QI and patient engagement functions,” researchers clarified.

Researchers put the onus on policymakers to drive greater adoption of tools to enhance EHR use through both direct funding for health IT and indirect incentives from value-based payment and delivery models.

“Policymakers may need to consider specific actions to target safety net hospitals, which could include funding as well as technical assistance with implementation,” they stated.

This most recent study confirms the findings of previous research that pinpoint small, rural, and critical access hospitals as weak spots in the healthcare industry’s push to advance technologically. For these hospitals, barriers to EHR adoption and use include cost, time consumption, provider perception of usefulness, transition of data, location of healthcare facility, and implementation.